This session is meant to help the diabetes educator who works in an inpatient or an
outpatient setting learn the issues surrounding hyperglycemia in the hospital. Transition of
patient care from inpatient to outpatient setting requires specific interventions to assure the
patient does not get lost in the healthcare system. Optimal glycemic management is a team effort
and requires system processes of which the diabetes educator can play a pivotal role. This
presentation offers specific examples of how to help initiate this change.

Nationwide, questions related to the perioperative management of known patients with
diabetes and stress induced hyperglycemia continue to be asked. Diabetes educators, advanced
practitioners, and health care providers are being called upon to develop guidelines for
preoperative instructions, intraoperative protocols and postoperative glycemic management. Yet,
there is still much disagreement in the scientific community regarding “best practice”. This
presentation will provide the latest research findings, standards and guidelines for practice, and
useful strategies for the acute care professional.

Computer technology has become an integral part of health education. Diabetes educators can
benefit from Internet tools. Participants will become familiar with factors that make a website a
quality source of diabetes information. Keeping pace with current practice guidelines and clinical
research poses a challenge for the busy educator. This presentation will deliver examples of useful
online diabetes resources for both the educator and patient. Interactive distance education for
professional development will be also be highlighted.

This presentation will cover the use of Continuous Glucose Monitoring (CGM) technology in
diabetes care. It will review the different types of CGM devices available for use and discuss the
research and clinical findings that may help identify patients who may benefit from the use of this
technology. Discussed will be highlights of patient education when preparing for the use of CGM,
and new and innovative means of integrating CGM use into clinical practice. Case studies will be
presented to help the audience to learn how to interpret the data provided by the various software
programs associated with the CGM systems.

Prescribing the most appropriate medication(s) is important to the patient’s treatment
success. With prescription in hand, the individual cascade of behaviors and critical decisions
begins for the patient. Multiple individual and environmental factors can lead to underutilization
of prescribed medications. As patients and providers strive to achieve optimal glycemic control,
complex regimens using multiple injectables are more common. In addition, staffing constraints
interfere with healthcare provider efforts. This session will spotlight an innovative program of
treatment options and other findings.

Health literacy is the ability to read, understand and act on health information. The need
for individuals, especially those living with a chronic disease like diabetes, to be health
literate is greater than ever because medical care is more complex and patients are expected to
carry out their own self-management. This interactive session will define the problem of health
literacy in the U.S. and discuss solutions to address the gap between what a patient hears and
understands from their provider or educator—and what is truly intended!

Billing and reimbursement continue to be an issue for hospitals and offices/clinics across
the country. In today’s diabetes practice, hospital programs are closing or developing new concepts
to transition the patient from hospital to home and presenting DSMT by collaborating with private
practice, family practice and pharmacies. Among the topics addressed at this session will be:
developing relationships with insurance case management programs and obtaining grants and other
funding to provide diabetes education for both insured and underserved populations.

The diabetes educator has a challenging nontraditional role in the hospital that contrasts
to many outpatient duties. When focusing on the hospital, the CDE also focuses on changing the
'system' to improve the care of the diabetes patient. The CDE serves as an evidence-based
practitioner who uses literature and data to guide hospital policy and practice. The CDE also
serves as a diabetes informatics specialist, providing crucial data to the administrators and CEO
of their facility's performance on diabetes outcomes. This session provides a simple, practical
approach to describing the glucose problems in the hospital, measuring and benchmarking data, and
implementing quality care and treatment initiatives.

As societal health needs continue to focus on the diabetes epidemic, health professionals
must explore new ways to assist patients to "live well" with the disease. Individuals need help
integrating the various aspects of their personhood (physical, psycho-social, sexual and spiritual)
into an overall sense of wellness. This presentation will challenge diabetes educators to consider
the concept of spirituality as integral to providing holistic, quality care.

For people with diabetes, celiac disease is a nutritional and diagnostic challenge.
Treatment requires permanent elimination of gluten from the diet. Some people with celiac disease
exhibit no symptoms. Those with diabetes and undiagnosed celiac disease may experience unexplained
hypoglycemia and symptoms attributed to gastroparesis. Learn how to identify celiac disease, create
gluten-free diets and manage glucose for the celiac impacted.

Diabetes is one of the leading causes of blindness worldwide. Leading contributing factors
include deficiencies in the quality of diabetes care, scarcity and denial of diabetes educators,
organizational deficiencies, scarce economic resources, and lack of interest. Starting in 2006,
agreements were made to deliver diabetes education to patients seeking education at the three
largest ophthalmology hospitals in Mexico City. As a requirement to receive diabetes education,
each patient completed a survey to assess the quality of care previously received. The results
documented serious deficiencies in the quality of diabetes care delivered at public and private
institutions in Mexico.

AADE's Professional Practice Committee (PPC) is a multidisciplinary committee that has
developed, or overseen, the development of several products to enhance the practice of diabetes
education and further the profession. These products include the Scope of Practice, Standards of
Practice and Standards of Professional Performance for Diabetes Educators, The Continuous Quality
Improvement monograph, position statements and a practice advisory. In addition, the PPC oversees
and interprets AADE's biannual National Practice Survey and has overseen the recent development of
the Guidelines for Practice of Diabetes Education, which defines levels of practice. This
presentation will show how these products can be used to enhance the practice of individual
educators and to advance the profession of diabetes education.

On February 27, 2009, AADE became a CMS-approved accrediting organization for outpatient
Diabetes Self-Management Education Programs. With the ever increasing numbers of patients being
diagnosed with diabetes, the demand for quality diabetes education programs continues to rise. AADE
is providing a DSMT accreditation option to healthcare professionals seeking to meet the needs of
the diabetes population in their community.

Internationally-known speaker, author and consultant Simon T. Bailey inspires individuals to
take charge of change and transform their lives from the inside out. Fortune 500 companies,
national associations, government agencies and educational institutions look to him to help release
the potential in their people. Dr. Bailey’s exciting keynote session will enable participants to
develop their personal brilliance and bring greater value to their work, relationships and daily
activities.

Diabetes Self-Management Education or Training (DSME/T or DSMT) focuses on providing
knowledge and information within a skills-based training and behavioral framework to reduce
complications and improve quality of life outcomes. While DSME/T has been shown to improve quality
of life and clinical outcomes, the impact of DSME/T on financial outcomes (cost of patient care)
has not been similarly studied. The impact of DSME/T on financial and clinical measures within a
large health plan dataset was also studied.

Concurrent Breakout Sessions
2:00 pm – 3:30 pm

Richard G. Roberts, MD, JD, FAAFP, FCLM
Professor of Family Medicine
University of Wisconsin School of Medicine & Public Health, Madison, WI

A large and growing body of evidence consistently demonstrates that healthcare systems based
on family medicine and primary care have betteroutcomes and lower costs than a specialist-dominant
system. Despite this, interest in and the viability of primary care is declining. Data will be
shared arguing for family medicine and a patient-centered medical home. The concepts of disruptive
innovation and practice redesigns will also be discussed, along with their likely impact on future
healthcare. The session concludes with a glimpse of healthcare 300 years in the future.

Gestational diabetes mellitus (GDM) is the most common complication of pregnancy, affecting
approximately four percent of women. GDM is associated with macrosomia, and neonatal hypoglycemia
in the infant and an increased risk of cesarean section and developing type 2 diabetes within 10
years after delivery. Speakers will review evidence-based guidelines for the management of GDM,
provide strategies for practice implementation, and define areas where additional research is
needed.

How do you keep your content focused and relevant? Teach interactively to engage the
learner? And make learning memorable? Experience the creative power of fellow participants and
experienced facilitators to build diabetes lesson plans which become living, breathing, useable
resources for curriculums. Guided by the AADE7™, participants will use a novel blueprint to
construct lesson plans which incorporate brain-based learning theories.

As the number of individuals with diabetes and prediabetes steadily increases, so does the
need for diabetes education and management programs. Yet in these difficult economic times, many
programs are downsizing or closing. Improve your program's sustainability, the number of clients
you are able to serve or perk up your existing sessions. One suburban program not only increased
their revenue over 100% in one year but increased the number of clients served, improved the level
of care delivered, and improved their participants' satisfaction and ability to make lifestyle
changes to enable them to live successfully with diabetes.

The consumption of fructose, primarily from high-fructose corn syrup (HFCS), has increased
considerably in the United States during the past several decades. Intake of HFCS may now exceed
that of the other major calorie sweetener, sucrose. Fructose could have potentially harmful effects
on other aspects of metabolism. The rise in non–alcoholic fatty liver disease (NAFLD) parallels the
increase in obesity and diabetes. There are hypotheses that increased fructose intake can result in
NAFLD. This session will discuss the role of fructose in obesity and hepatic disease, if any.

Diabetes has been singled out as a disease whose management often reflects poor quality and
needs improvement. This intensive adherence study describes the quality of diabetes care in an
ambulatory practice setting using measures of performance taken from the National Diabetes Quality
Improvement Alliance and the ADA Clinical Practice Guidelines. The sample was generated through an
electronic query of 69,000 patients with diabetes. Patient characteristics (age, gender, ethnicity,
insurance type) were explored in addition to the process of care measures (testing and frequency of
HbA1c, lipid profile, blood pressure, urinalysis for microalbuminuria) as well as associated
clinical health outcomes.

Non-IgE mediated adverse food reactions can be an important symptom provoking a component of
diabetes and co-morbid symptoms of diabetes. They are a common cause of many chronic conditions and
affect an estimated 15-20 percent of the general population. Identify the foods and chemicals
triggering inflammation and learn how dietary changes specific to the individual and clients can
reap benefits!

Evidence-based practice (EBP) has been used in diabetes management and plays a crucial part
of everyday practice, especially when updating knowledge and evaluating outcomes. However, the
fundamentals of EBP have changed over the years, resulting in misconceptions, frustration and a
backlash towards EBP. The purpose of this presentation is to review the concepts of EBP and discuss
how this may be implemented successfully into everyday practice. This presentation will review
research paradigms, discuss the concepts of best evidence, and outline and use examples of EBP as
they relate to diabetes education and management.

Diabetes affects nearly 23 million Americans—eight percent of the population. Yet six
million of these people are not aware that they have the disease. In 2007, diabetes was the seventh
leading cause of death in the United States. In 2002, the National Cancer Institute estimated that
there are more than 10.1 million Americans with a history of cancer, and about 1.4 million new
cases of cancer were expected to be diagnosed in 2006. As incidences of both diabetes and cancer
arise, the number of cancer patients with diabetes will increase as well. Preliminary research
involving cancer patients with diabetes has revealed that treatment of hyperglycemia/diabetes may
result in better cancer outcomes.

Learn why over 300,000 diabetes patients contact the American Diabetes Association's
National Call Center every year. Discover why they call, the educational gaps that exist for them,
and the benefits of utilizing call centers as a reliable health education tool.

Physical activity has been shown to be an important health-related behavior. Physical
inactivity is a behavior that is likely to be long-standing. Therefore, physical activity is a
behavior that requires change or modification. Although the benefits of exercise and physical
activity are known, population trends show that a large percentage of adults and children are not
physically active at a level that will allow for these health benefits. Diabetes educators have to
understand the principles of physical activity behavior change and educate patients to adopt a
regular and consistent activity programs.

Active group ownership of a support group is a balance between autonomy and maintaining
professional leadership. Many support group participants find it preferable to leave leadership and
education to the experts. Because of this, the individual's considerable knowledge and experience
regarding diabetes self-management are too often hidden from the rest of the group. This
interactive presentation will explore the role of the professional facilitator, focusing on ways of
tapping into the leadership skills and creative problem solving within the group itself.

With the support of numerous partners, such as the NDEP AAPI Workgroup, the Association of
Asian Pacific Community Health Organizations (AAPCHO) has created the Health Information Gateway: a
tool that makes available online a range of high-quality, Asian American, Native Hawaiian and
Pacific Islander (AAPI)-related diabetes education materials for a mass audience. The site is also
a community capacity-building tool that enables AAPCHO to raise the standards of AAPI health
education materials by employing the expertise found within the AAPI community.

There is compelling evidence that sleep disorders, obesity and impaired glucose metabolism
not only co-exist but also frequently exacerbate each other. The current epidemic of obesity is a
risk factor for both obstructive sleep apnea and type 2 diabetes. This presentation will review
normal sleep and factors such as increased age, circadian rhythm, medications and sleep disorders
that can modify sleep—and impact diabetes for both better or worse.

S30a
Research Presentations: Behavior Change
Why WAIT?- Multidisciplinary Program for Weight Control in Obese Patient with Diabetes- 1
Year Later

Amanda Kirpitch
Nutrition Educator
Joslin Diabetes Center, Boston, MA

Research Hypothesis, Purpose, or Objective: To Our goal was to facilitate modest, sustainable
weight loss and improvement in a number of other health parameters in a population of obese
patients with diabetes using a structured, multi-disciplinary 12-week weight management
program.

Study/Design Methods: 85 participants with mean age (54.2 ±1.2 years), diabetes duration (9.8
±1.1 years), weight (235.3 ±4.6 pounds), BMI (38.4 ± .6 kg/m2), and waist (46.7 ± .6 inches) were
enrolled in the 12-week program and have been followed for an additional year. Patients followed a
structured, modified dietary intervention based on the Joslin Nutrition Guidelines with a
macronutrient distribution of 40% carbohydrates, 30% protein, and 30% fat. This included a meal
replacement for breakfast and lunch during the first 10 weeks of the program. Structured dinner
menus were provided. The patients transitioned to breakfast and lunch menus by the end of the
program. All participants engaged in an individualized, graded, and balanced exercise plan that was
demonstrated in 1-hour weekly sessions and transitioned to their home workout routines. Patients
also received cognitive behavioral intervention throughout the program provided by a clinical
psychologist.

Results: After 12 weeks, average weight decreased by 24.6 pounds (10.3%) and at one year 55
percent have maintained weight loss or continued to lose weight. Average weight loss at one year
was 18.2 pounds (7.3% of initial weight). Body composition improved with a 40.2% decrease in body
fat (p<.001) and a 1.8% (p<.05) decrease in their lean/fat ratio. Glycemic control improved
with A1C drop from 7.5%-6.6% at 12-weeks. At 1 year, A1C was 7% in the participants that continued
to lose weight and increased to 7.8% in those that regained weight. Total Cholesterol and
LDL-cholesterol decreased 10.8% and 9.6% respectively (p<.01). Triglycerides also decreased by
18.2% (p<.001). Urinary albumin/creatinine ratio decreased at 1 year from 29.4 mcg/mg to 25
mcg/mg (p<.01). Inflammatory markers improved with an increase in Adiponectin from 6.7 µg/mL to
11.6 µg/mL (p<.01) and a decrease in TNF-a from 3.99 pg/mL to 2.96 pg/mL (p<.05) at months.
C-reactive protein was also decreased from 6.1 mg/L to 4.4 mg/L at one year compared to baseline
(p<.01). These results were achieved along with a decrease in medication resulting in a cost
savings of approximately $560 per pt per year.

Conclusions: A 12 week weight multidisciplinary weight management program is successful in
reducing not only weight, but improving diabetes control, and other health parameters in obese
patients with diabetes.

Research Hypothesis, Purpose, or Objective: Health care providers are in a unique position to
influence patient health behaviors. Patients with diabetes and metabolic syndrome face particularly
complex behavior changes in that they are required to make changes on many behaviors at one time,
including the lifestyle challenges of diet and physical activity. Research suggests that many
providers lack the communication skills needed to help patients decide to make a lasting change.
Motivational interviewing (MI) is a skill set designed to help a patient find his/her internal
motivation to change and has been shown to improve behavior change and patient outcomes across many
types of behaviors. A 2 1/2 day MI training program based on adult learning theory has been
developed and delivered to health care providers working with patients with any or all of the
diseases of metabolic syndrome. The purpose of this study was to evaluate and report 1) the
learning outcomes of training participants in this training and 2) the self-reported outcomes of
the patients with whom they have applied the MI skills they learned in the training program.

Study/Design Methods: Five MI training programs were offered at Auburn University in 2007/2008.
The programs were attended by 189 nurse case managers, pharmacists, social workers, psychologists,
physicians, and others, many of whom were certified diabetes educators. The 2 1/2 day program was
designed to give participants the opportunity to develop both the cognitive and applied aspects of
MI skills development through active training exercises that started out in groups with facilitated
discussion, and progressed to individual exercises and role playing with feedback, and ended with
two Objective Structured Clinical Exam (OSCE) cases with standardized patients. The primary
objective of this progressive strategy was to help participants build confidence in their abilities
to use the MI skills and to learn from each other. After the programs participants were added to a
discussion list serve where they could post challenging patient cases and give each other feedback
about how to respond using MI. Participants were assessed before and after each training for
self-report of confidence, understanding, competence, and overall performance for using the MI
skills. Four months after the fifth program, an online survey was sent to all participants, asking
similar questions, but also including questions about MI use and patient impact since the
training.

Results: Average achievement scores on the two OSCEs were 86.46% and 84.03%. Mean program pre
and post tests score for understanding of MI concepts were pre: 2.56 (+/- 0.98)and post: 4.14 (+/-
0.58). For confidence, mean pre test score was 2.36 (+/- 1.08) and post was 3.90 (+/- 0.77); for
competence, pre scores were 2.12 (+/- 0.96) and post were 3.39 (+/- .73). In addition, participants
rated themselves as proficient at the MI skills of expressing empathy, supporting self-efficacy,
and avoiding argumentation and needing more work for rolling with resistance and developing
discrepancy. Survey: 114 of 189 responded. Participants were 87% female, 61% nurses (29%
pharmacists, 10% other), ~47.9 years old, practiced for ~22.7 years, and at current setting for
~7.4 years, were more effective after the MI training (86% self-rated at 4 or 5), are now using MI
skills with 63.36% of their patients, estimate that 68.67% of their patients have better outcomes
because of MI use, including improved medication adherence, smoking cessation efforts, weight loss
(60 lbs for 1, nearly 100 for 2 more), better blood sugars, blood sugar monitoring, starting
exercise regimens, decreased blood pressure, cost savings, decrease in unnecessary ER visits,
retaining more patients in case management program.

Conclusions: MI training based on a progression of adult learning theory-based exercises may
help build provider confidence and effectiveness in communicating with patients about health
behavior change, particularly in relation to the complicated behavior changes necessary for
diseases of the metabolic syndrome. There are limitations to the study, and given the descriptive
design no causal inferences can be made.

Research Hypothesis, Purpose, or Objective: Integrative Health Coaching (IHC) may be
particularly useful for patients with type II diabetes given the myriad behavior changes they need
to make and sustain for optimal health. This innovative approach may provide a unique way for
patients to improve medication adherence, better understand their barriers to change and empower
them to make both behavior and psychosocial changes. Hypothesis 1: IHC will improve medication
adherence and HbA1c. Hypothesis 2: The ASK-20 Questionnaire will facilitate IHC by targeting
barriers to medication adherence. Hypothesis 3: IHC will facilitate behavior change. Hypothesis 4:
IHC will increase psychosocial functioning.

Study/Design Methods: Integrative Health Coaching (IHC) may offer an innovative way to address
the estimated 90% of patients with diabetes who do not adhere to their treatment plans. IHC is a
unique collaborative process distinct from health education. In IHC, the patient considers both
their physical and mental health, i.e., personal growth and healthy coping as well as healthy
lifestyle behaviors. The patients themselves set the agenda by assessing their health risks and
readiness to change, setting their own health goals and choosing action steps to accomplish their
individual goals. Medication adherence, healthy eating, physical activity, stress management, and
coping skills are all discussed; however, emphasis is not placed on advising or educating. Instead
the health coach explores the patient's own agenda with curiosity, intuition and open-ended
questions. Design: As part of a larger study, 48 participants [age=53.2(8.31), 23% male, 56%
African-American, 44% with a college degree] were offered 14 individual telephonic IHC sessions of
20-30 minutes over six months. At a pre-coaching (baseline) and post-coaching (six months later)
visit, participants were evaluated for HbA1c and a number of behavioral and psychosocial issues.
Self-reported questionnaires measured medication adherence, barriers to adherence, patient
activation, exercise behavior, perceived stress, mood and social support.

Results: Participants with baseline HbA1c greater than 7.0 (n=29) demonstrated a significant
HbA1c reduction of 0.6 [9.0(1.75) to 8.4(1.74), p=0.024]. For the entire group of participants
(n=48), barriers to medication adherence decreased [ASK-20: 42.2(8.14) to 36.9(9.10), p=0.001] and
medication adherence improved [Morisky: 6.8(1.10) to 7.2(1.06), p<0.001] as a function of the
intervention. Patient activation, defined as knowledge, skills and confidence for self-management,
increased [PAM: 65.5(17.32) to 77.4(18.25), p<0.001]. In addition, participants reported
decreases in perceived stress [PSS-4: 5.7(3.29) to 4.4(3.05), p=0.013] and depression symptoms
[Burns Mood Scale: Wilcoxon Test, p=0.002]; reductions in anxiety and anger scores were not
significant. Participants noted greater social support in both tangible and intangible domains
[ISEL-12: 38.0(7.84) to 41.2(7.14), p=0.001]. Physical activity increased as well. Across six
months of coaching, participants with low baseline levels of physical activity (fewer than once per
week) increased the reported frequency of aerobic exercise [n=27, Wilcoxon Test: p=0.006],
stretching [n=32, Wilcoxon Test: p=0.004] and muscular strengthening [n=41, Wilcoxon Test:
p=0.015]. Finally, patients improved their overall morale regarding having diabetes [ADS:
17.7(5.09) to 15.31(4.56), p<0.001] and were able to perceive diabetes as making more positive
contributions to their lives (e.g., greater acceptance) [Benefit Finding Scale: 47.1(21.20) to
51.2(20.85), p=0.006].

Conclusions: Distinct from health education in its philosophy and practice, Integrative Health
Coaching appears to be a powerful intervention to improve multiple biochemical, behavioral and
psychosocial targets for patients with type II diabetes.

Concurrent Breakout Sessions
3:45 pm – 5:15 pm

Dosing formulas provide estimates for initiating and evaluating existing insulin dosing in
pump-treated patients. The Diabetes Care Center has enlarged a previous database of CGM-titrated
pump-treated type 1 diabetic patients to 61 and will report the derived dosing formulas from this
group. Current widely-used dosing formulas have been derived from ‘well-controlled’ (defined by
HbA1c) pump-treated patients. However, HbA1c fails to reflect post-meal or overnight glucose
control. Proposed changes in the dosing estimation formulas will also be discussed.

Tift Regional Medical Center is a self-insured rural hospital employing approximately 1,500
people and located in a region with the highest prevalence of diabetes in Georgia. With
approximately 30% of employees identified as having elevated blood glucose values during the 2007
annual employee health screening, an employee diabetes management program was developed to aid
employees in achieving acceptable glycemic control and to control the medical cost burden to the
self-insured hospital. Procedures were developed to interact with the employee primary care
physician to aid in achieving glycemic control.

The presentation will describe the Federal Trade Commission’s efforts to urge the food
industry and its media partners to improve the nutritional profile of foods marketed to children
and to change the way those foods are marketed. The presentation will describe the legal landscape
surrounding government regulation of food marketing to children, and will report on the results of
public workshops and studies the FTC has conducted, including the FTC’s landmark 2008 study that
reported on both how much industry spends marketing food to children and the myriad ways it markets
to children. The presentation will also discuss the efforts of the Congressionally mandated
interagency working group consisting of the FTC, FDA, CDC, and USDA, to develop nutrition standards
for food marketing to children. Finally, the presentation will describe the FTC’s efforts to
address marketing scams targeted to consumers seeking to lose weight or to control their diabetes.

Recent studies show that the use of Web-based telemonitoring can assist the diabetes
educator in promoting glycemic control. Diabetes complication prevention includes hypertension
control, BG monitors and BP monitors connect to the telemonitor and transmit the test results
directly to the caregiver’s website. They can then communicate with the patient via e-mail or phone
based on the data received. All can be a powerful patient motivator. Strategies will address the
adaptations required to effectively utilize web-based telemonitoring for glycemic and hypertension
control and self-management education. The multi-ethnic population base includes patients from
Bangladesh, Pakistan, Haiti, Guyana as well as African American and Hispanic patients.

Many Americans live in poverty and Alabama is one of the poorest states. This presentation
will explore the culture of poverty and identify methods to assist poor clients with chronic health
needs. Discussion will include the processes and outcomes from a successful diabetes indigent care
program at the East Alabama Medical Center. The program, which started in 2000, provides education,
transportation assistance and blood glucose monitoring supplies to the medically underserved
population in five Alabama counties.

The shift from sliding scale to basal/bolus insulin order sets is a major institutional
change that affects the work flow of many departments hospital-wide. Using change management
theories and tools, the attendee will learn how Spectrum Health Hospital systematically set the
stage for deliberate and controlled changes that resulted in improved inpatient glycemic control.

It is often said that nutrition therapy never works, so just prescribe medications. Weight
loss is assumed to be the answer to all problems—but when is it effective, and if it isn't, why
not? The glycemic index has been proposed as the answer as to what to eat. Carbohydrates are
assumed to cause insulin resistance. Low carbohydrate diets are really the answer as to what to
eat. Patients often report being too busy to participate in physical activities. These—and other
nutrition dilemmas faced by diabetes educators—will be addressed at this provocative session.

The development of a multidisciplinary 'Glucose Management Team' in a large tertiary care
facility has resulted in the development of tools for achieving normoglycemia in all hospitalized
patients. A frank panel discussion of the successes and pitfalls encountered will be presented by
diabetes educators who made significant contributions to this process. Tools such as order sets,
protocols, an IV insulin management system with 'downtime' procedures, and the transition to
carbohydrate counting will be also be addressed.

Successful diabetes self-management training does not have to be provided in traditional
settings. Many clients do not have insurance to provide DSMT services. Educators can collaborate
with physicians and clinics to provide education at what are traditionally diabetes wellness visits
at the clinic. Barton County Memorial Hospital's format includes a presentation to the group,
reviewing or formulating a meal plan by the dietitian, medication review and lab reviews, foot
exams, goal setting by the nurse educators, and a wellness exam provided by the doctor or nurse
practitioner. Data presented will show outcomes that prove the group visit is an effective form of
education to the uninsured and underinsured.

Education is a key component in diabetes management. While the vast majority of education
takes place in the clinic setting, it can be difficult for families to apply this education to
everyday living. Akron's Children's Hospital decided to create a camp solely for patients and staff
it with the exact team that cares for them in clinic. This way they could continue to reinforce the
methods of diabetes management in real-life situations. Diabetes educators played a prominent role
in the camp experience and they were able to capitalize on teaching opportunities presented
throughout the week. This model offers an option for diabetes education.

The Missouri Foundation for Health funded the Better Self-Management of Diabetes program to
demonstrate innovative ways for people living with diabetes to improve their quality of life
through improved self management. Grace Hill Neighborhood Health Centers, Inc., and Myrtle Hilliard
Davis Comprehensive Health Centers have utilized two different models using healthcare coaches in
the urban community primary health care setting for the past decade. One site describes how the use
of multicultural coaches addressed the needs of their new immigrant population through the use of
holistic care classes. The other focuses on the multiple services provided by coaches and how these
activities are integrated into the delivery system.

This innovative model expands the role of the diabetes educator to assure competency care
for children with diabetes in the schools. The South Carolina "School Nurse Connect" program began
with the collaboration of the state school nurse consultant and the state diabetes and disparities
consultant. Further collaboration with the National Association of School Nurses resulted in a
comprehensive diabetes needs assessment tool, 15 educational modules and plans to establish a
web-based continuing education program. In only six months, 111 school nurses in 12 counties have
completed diabetes care needs assessment and 67 have begun education sessions.